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Clinical Toxicology

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June 14, 2018: Clinical Toxicology
Marcee E Wilder, Lynne D Richardson, Robert S Hoffman, Gary Winkel, Alex F Manini
OBJECTIVES: Racial and ethnic disparities in the United States continue to exist in many disciplines of medicine, extending to care in the Emergency Department (ED). We sought to examine the relationship between patient race/ethnicity and use of either antidotal therapy or gastrointestinal decontamination for individuals presenting to the ED for acute drug overdose. METHODS: We completed a secondary analysis of a prospective cohort of patients with suspected acute overdose presenting to two urban tertiary care hospitals between 2009 and 2014...
June 12, 2018: Clinical Toxicology
Matthieu Grégoire, Alain Pineau, Cédric Bretonnière, Joyce Niang, Karim Lakhal, Guillaume Deslandes
No abstract text is available yet for this article.
June 12, 2018: Clinical Toxicology
Nicolás Fernández, Florencia Falguera, Laura M Cabanillas, Patricia N Quiroga
No abstract text is available yet for this article.
June 12, 2018: Clinical Toxicology
Kirushanthi Sakthithasan, Pierre Lévy, Joël Poupon, Robert Garnier
BACKGROUND: We evaluated the efficacy of two antidotes, edetate calcium disodium (CaNa2 EDTA) and dimercaptosuccinic acid (DMSA), for the treatment of lead poisoning in adults. METHODS: Thirty-seven patients with blood lead concentrations >40 μg/dL and positive CaNa2 EDTA lead mobilization were randomized to receive 1050 mg/m2 /day of oral DMSA (n = 21) or 500 mg/m2 /day of intravenous CaNa2 EDTA (n = 16) over two five-day courses separated by a 10-day rest period...
June 11, 2018: Clinical Toxicology
Théo Willeman, Raphael Marlu, Holger Böhle, Gilles Francony, Jean-François Jourdil, Xavier Fonrose, Françoise Stanke-Labesque
BACKGROUND: Ticagrelor is a direct and reversible competitive antagonist of the P2Y12 receptor and inhibits platelet activation. Although adverse bleeding is common, fatal intoxication has never been documented. CASE DESCRIPTION: A 47-year-old man died from a severe cerebral hemorrhage secondary to a fall and cranial trauma 4 d after the massive intake of ticagrelor. Iterative platelet transfusions did not improve his condition. Toxicological analyses by liquid chromatography tandem mass spectrometry (LC-MS/MS) revealed high plasma concentrations of ticagrelor (3343 µg/L) and its active metabolite AR-C124910XX (656 µg/L) 10 h after intake...
June 11, 2018: Clinical Toxicology
Hai-Ling Yuan, Tian-Cai Yang, Wen Zhang, Zhu-Ming Wu
No abstract text is available yet for this article.
June 11, 2018: Clinical Toxicology
Nathan C Stam, Jennifer L Pilgrim, Olaf H Drummer, Karen Smith, Dimitri Gerostamoulos
BACKGROUND: The aim of this study was to investigate the safety of the management of non-fatal heroin overdose in the out-of-hospital environment; irrespective of whether or not naloxone had been administered. Heroin toxicity-related deaths as well as heroin intoxication-related traumatic deaths following patient-initiated refusal of transport were investigated. METHODS: Heroin-related deaths in the state of Victoria, Australia between 1 January 2012 and 31 December 2013 were investigated and data linkage to pre-hospital Emergency Medical Services performed, in order to identify whether the death was related to the last episode of care by paramedics...
June 6, 2018: Clinical Toxicology
Jeanna M Marraffa, Christine M Stork, Robert S Hoffman, Mark K Su
BACKGROUND: Interest in tianeptine as a potential drug of abuse is increasing in the United States. We performed a retrospective study of calls to the New York State Poison Control Centers (PCCs) designed to characterize one state's experience with tianeptine. METHODS: Data were gathered from existing records utilizing the poison center data collection system, Toxicall® entered between 1 January 2000 through 1 April 2017. Information regarding patient demographics, reported dose and formulation of tianeptine, reported coingestants, brief narrative description of the case, disposition, and case outcome was collected...
May 25, 2018: Clinical Toxicology
Lars E Schmidt, Ditlev N Rasmussen, Tonny S Petersen, Ines M Macias-Perez, Leo Pavliv, Byron Kaelin, Richard C Dart, Kim Dalhoff
CONTEXT: The intravenous (IV) N-acetylcysteine (NAC) regimen used worldwide in paracetamol overdose is complex with three separate weight-based doses and is associated with a high incidence of adverse events including non-allergic anaphylactoid reactions (NAARs). In 2012, Denmark adopted the two-bag IV NAC regimen which combined the first two infusions of the three-bag regimen and kept the third infusion unchanged. We compared the safety and efficacy of the two-bag IV NAC regimen with the traditional Danish three-bag regimen...
May 24, 2018: Clinical Toxicology
Robert D Cox, Christina S Parker, Erin C E Cox, Michael B Marlin, Robert L Galli
INTRODUCTION: Copperhead (Agkistrodon contortrix) and cottonmouth or water moccasin (Agkistrodon piscivorus) snakes account for the majority of venomous snakebites in the southern United States. Cottonmouth snakes are generally considered to have more potent venom. Copperheads are considered less venomous and there is some controversy as to whether or not bites from copperhead snakes need to be treated with antivenom. Copperhead and juvenile cottonmouth snakes are both brown in color...
May 24, 2018: Clinical Toxicology
Hoang X Pham, Michael E Mullins
INTRODUCTION: Current management guidelines for pit viper envenomations recommend against the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control due to concern for platelet dysfunction and resulting coagulopathy. However, prior research suggests that copperhead snakes generally do not cause coagulopathy and they are responsible for most of the venomous snakebites in the USA. Thus, we compared the occurrences of clinically apparent bleeding and most abnormal laboratory values of coagulation between copperhead envenomation patients who received NSAIDs and those who did not...
May 18, 2018: Clinical Toxicology
Camille Bataille, Lise Capaldo, Arnaud Courtois, Benjamin Seguy, Clémence Lotiron, Magali Labadie
No abstract text is available yet for this article.
May 15, 2018: Clinical Toxicology
(no author information available yet)
No abstract text is available yet for this article.
May 15, 2018: Clinical Toxicology
J Allister Vale, Timothy C Marrs, Robert L Maynard
No abstract text is available yet for this article.
May 14, 2018: Clinical Toxicology
Bradley R Burmeister, Jacqueline A Schabold, Amy E Zosel
No abstract text is available yet for this article.
May 9, 2018: Clinical Toxicology
Marie Deguigne, Marion Brunet, Chadi Abbara, Alain Turcant, Gaël Le Roux, Bénédicte Lelièvre
OBJECTIVE: We report two cases of elevated digoxin plasma levels in patients receiving enzalutamide. Cases reported: The first patient, an 84-year-old male treated with enzalutamide, was hospitalized due to deterioration in his general state. Atrial fibrillation was discovered and treatment with digoxin was initiated. Supratherapeutic digoxin concentrations (4 µg/L and 3.5 µg/L 3 days later) led to treatment being stopped despite the lack of clinical or biological signs of overdose...
May 9, 2018: Clinical Toxicology
(no author information available yet)
No abstract text is available yet for this article.
May 2, 2018: Clinical Toxicology
Kurt Kleinschmidt, Anne-Michelle Ruha, Sharan Campleman, Jeffrey Brent, Paul Wax
BACKGROUND: Crotalidae Polyvalent Immune Fab (Fab Antivenom) is the primary Viperid antivenom used in the United States since 2000. Adverse event data associated with its use are limited. The purpose of this study is to describe the prevalence of acute adverse events associated with the use of Fab antivenom. METHODS: The American College of Medical Toxicology's Toxicology Investigators Consortium maintains a prospective case registry of poisoned and envenomated patients managed by medical toxicologists at the bedside...
April 24, 2018: Clinical Toxicology
Adam Rieves, Michael Mullins
No abstract text is available yet for this article.
April 24, 2018: Clinical Toxicology
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